When evaluating the implications of competitive strategies in healthcare for quality, it is important to understand how patients choose providers, the factors that may constrain patients' choices, and the demand-driven incentives facing providers. This proposal describes a study to measure the impact of center-specific survival rates and patient characteristics on patients', physicians', and payers' choice of kidney transplant center This study will address five specific research questions. 1. Do center-specific outcomes influence patients', physicians', and health plans' choice of transplant center? 2. Did the release of center-specific kidney graft survival data on the Internet lead patients to place more weight on outcomes when choosing transplant centers? 3. Are educated patients more likely and minority patients less likely to use center-specific outcomes data when choosing transplant centers? 4. Are sicker patients more or less responsive to center-specific outcomes data? 5. Are privately insured patients, whose choice of transplant center may be restricted by their insurers, more or less likely to register at transplant centers with high risk-adjusted survival rates? The dataset will consist of observations on all patients registering for a cadaveric kidney transplant between January 1, 1999 and October 31,2002, excluding previously transplanted patients, pediatric patients, and multi-organ transplant candidates (N>50,000). Using a mixed Iogit model of choice, which is similar to a conditional Iogit model, we will estimate the impact of center-specific graft survival rates, travel distance, and past market share and interactions of each of these transplant center attributes with patient characteristics on the likelihood that a transplant center is chosen by a patient. Using these estimates, we will simulate the impact of changes in survival rates on market shares for the groups of patients mentioned above.